Dataset Information

Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.

ABSTRACT: BACKGROUND:Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. RESULTS:Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. CONCLUSIONS:Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

SUBMITTER: Eberly LA

PROVIDER: S-EPMC7183732 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.

Eberly Lauren A LA Richterman Aaron A Beckett Anne G AG Wispelwey Bram B Marsh Regan H RH Cleveland Manchanda Emily C EC Chang Cindy Y CY Glynn Robert J RJ Brooks Katherine C KC Boxer Robert R Kakoza Rose R Goldsmith Jennifer J Loscalzo Joseph J Morse Michelle M Lewis Eldrin F EF Abel Samantha S Adams Ayrenne A Anaya Joseph J Andrews Erik H EH Atkinson Benjamin B Avutu Viswatej V Bachorik Alexandra A Badri Omar O Bailey Mariel M Baird Katie K Bakshi Salina S Balaban Denis D Barshop Kenneth K Baumrin Emily E Bayomy Omar O Beamesderfer Julia J Becker Nora N Berg David D DD Berman Adam N AN Blum Steven M SM Boardman Alexander P AP Boden Kaeleen K Bonacci Robert A RA Brown Sarah S Campbell Kirsti K Case Siobhan S Cetrone Emily E Charrow Alexandra A Chiang David D Clark Devin D Cohen Aaron J AJ Cooper Alissa A Cordova Tomas T Cuneo C Nicholas CN de Feria Alsina Alejandro AA Deffenbacher Karen K DeFilippis Ersilia M EM DeGregorio Geneva G Deutsch Aaron J AJ Diephuis Bradford B Divakaran Sanjay S Dorschner Peter P Downing Nicholas N Drescher Caitlin C D'Silva Kristin M KM Dunbar Peter P Duong David D Earp Sarah S Eckhardt Christine C Elman Scott A SA England Ross R Everett Kay K Fedotova Natalie N Feingold-Link Tamara T Ferreira Mark M Fisher Herrick H Foo Patricia P Foote Michael M Franco Idalid I Gilliland Thomas T Greb Jacqueline J Greco Katherine K Grewal Sungat S Grin Benjamin B Growdon Matthew E ME Guercio Brendan B Hahn Cynthia K CK Hasselfeld Brian B Haydu Erika J EJ Hermes Zachary Z Hildick-Smith Gordon G Holcomb Zachary Z Holroyd Kathryn K Horton Laura L Huang George G Jablonski Stanley S Jacobs Douglas D Jain Nina N Japa Sohan S Joseph Richard R Kalashnikova Mariya M Kalwani Neil N Kang Daniel D Karan Abraar A Katz Joel T JT Kellner Daniel D Kidia Khameer K Kim June-Ho JH Knowles Scott M SM Kolbe Laura L Kore Idil I Koullias Yiannis Y Kuye Ifedayo I Lang Joshua J Lawlor Matthew M Lechner Melissa G MG Lee Ken K Lee Scott S Lee Zachary Z Limaye Neha N Lin-Beckford Stephanie S Lipsyc Marla M Little Jessica J Loewenthal Julia J Logaraj Ranjani R Lopez Diana M DM Loriaux Daniel D Lu Yi Y Ma Kevin K Marukian Nareh N Matias Wilfredo W Mayers Jared R JR McConnell Ian I McLaughlin Michael M Meade Christina C Meador Catherine C Mehta Anish A Messenger Elizabeth E Michaelidis Constantinos C Mirsky Jacob J Mitten Emilie E Mueller Alisa A Mullur Jyotsna J Munir Amir A Murphy Emily E Nagami Ellen E Natarajan Abirami A Nsahlai Michelle M Nze Chijioke C Okwara Noreen N Olds Peter P Paez Rafael R Pardo Michael M Patel Siddharth S Petersen Alec A Phelan Laura L Pimenta Erica E Pipilas Daniel D Plovanich Molly M Pong Denise D Powers Brian W BW Rao Anita A Ramirez Batlle Haiyan H Ramsis Mattheus M Reichardt Anna A Reiger Sheridan S Rengarajan Michelle M Rico Stephanie S Rome Benjamin N BN Rosales Rachael R Rotenstein Lisa L Roy Alexis A Royston Sarah S Rozansky Hallie H Rudder Meghan M Ryan Christine E CE Salgado Sanjay S Sanchez Pablo P Schulte Jennifer J Sekar Aswin A Semenkovich Nicholas N Shannon Evan E Shaw Neil N Shorten Andrew Ben AB Shrauner William W Sinnenberg Lauren L Smithy James W JW Snyder Gregory G Sreekrishnan Anirudh A Stabenau Hans H Stavrou Eleni E Stergachis Andrew A Stern Robert R Stone Alexander A Tabrizi Shervin S Tanyos Sam S Thomas Cristina C Thun Haley H Torres-Lockhart Kristine K Tran An A Treasure Carolyn C Tsai Frederick D FD Tsaur Stephen S Tschirhart Evan E Tuwatananurak Justin J Venkateswaran Ramkumar V RV Vishnevetsky Anastasia A Wahl Lindsay L Wall April A Wallace Frances F Walsh Elisa E Wang Priscilla P Ward Heather B HB Warner Lindsay N LN Weeks Lachelle D LD Weiskopf Kipp K Wengrod Jordan J Williams Jessica N JN Winkler Marisa M Wong Jeffrey L JL Worster Devin D Wright Aileen A Wunsch Caroline C Wynter Jamila S JS Yarbrough Chase C Yau Wai-Ying WY Yazdi Daniel D Yeh Jennifer J Yialamas Maria A MA Yozamp Nicholas N Zambrotta Marina M Zon Rebecca R

Circulation. Heart failure 20191029 11

<h4>Background</h4>Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to ...[more]

PMID: 31658831

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Project description:Background Inequitable access to high-technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code-level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs. Methods and Results We conducted cross-sectional analyses of Medicare fee-for-service claims for beneficiaries aged 66 years or older between 2016 and 2019. We identified hospitals establishing LAAO programs during the study period. We used generalized linear mixed models to measure the association between zip code-level racial, ethnic, and socioeconomic composition and age-adjusted rates of LAAO in the most populous 25 metropolitan areas with LAAO sites. During the study period, 507 candidate hospitals started LAAO programs, and 745 candidate hospitals did not. Most new LAAO programs opened in metropolitan areas (97.4%). Compared with non-LAAO centers, LAAO centers treated patients with higher median household incomes (difference of $913 [95% CI, $197-$1629], P=0.01). Zip code-level rates of LAAO procedures per 100 000 Medicare beneficiaries in large metropolitan areas were 0.34% (95% CI, 0.33%-0.35%) lower for each $1000 zip code-level decrease in median household income. After adjustment for socioeconomic markers, age, and clinical comorbidities, LAAO rates were lower in zip codes with higher proportions of Black or Hispanic patients. Conclusions Growth in LAAO programs in the United States had been concentrated in metropolitan areas. LAAO centers treated wealthier patient populations in hospitals without LAAO programs. Within major metropolitan areas with LAAO programs, zip codes with higher proportions of Black and Hispanic patients and more patients experiencing socioeconomic disadvantage had lower age-adjusted rates of LAAO. Thus, geographic proximity alone may not ensure equitable access to LAAO. Unequal access to LAAO may reflect disparities in referral patterns, rates of diagnosis, and preferences for using novel therapies experienced by racial and ethnic minority groups and patients experiencing socioeconomic disadvantage.

Dataset Information

Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.

Publications

Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.

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